An Open Letter to Members of Congress

Luca Bertolli

On April 21, 2015, I posted an Open Letter to the 2016 Presidential Candidates that outlined 12 suggested strategies for responding to the devastating consequences of surging opioid use and opioid addiction in the United States. Unfortunately, most presidential campaigns provided few forums for substantive discussions of drug policy among our potential leaders.

The drug control policies of President Donald Trump remain unclear. There was a time when the White House Office of National Drug Control Policy (ONDCP) seemed itself on the budgetary chopping block and ONDCP's fate and future role remain unclear. President Trump's repeated promise to prevent drugs from coming into the country is challenged by decades of similar promises made by his predecessors and ignores the role prescription opioids have played and continue to play in the opioid epidemic. And his proposal to expand addiction treatment is contradicted by the current GOP proposal to replace the Affordable Care Act (ACA).

In the coming weeks, you as members of the House of Representatives and Senate, will be debating and voting on the GOP health care reform proposal. Your decisions will have enormous influence on the future health of American citizens and a profound influence on the individuals, families, and communities affected by addiction to opioids and other drugs. The number of drug overdose deaths each year in the U.S. now surpasses annual deaths from car crashes, annual deaths from gun-related homicides, and the peak year of deaths from AIDS. Opioids alone account for more than 33,000 overdose deaths per year, and those deaths are rising exponentially in key states that led to Republican victories in the 2016 presidential and congressional elections.

Two of the most important responses to the opioid epidemic have been the ACA's expansion of Medicaid in 31 states and the District of Columbia and the ACA requirement that states include mental health and addiction treatment as reimbursable services. Those critical responses will be turned back if the GOP health reform proposal is passed in its current form. The toll of such regression will be measured in lost lives, distressed families, and weakened communities and community institutions. It may also be measured in lost political careers.

The best components of the ACA--both its general health care provisions and its stipulations on mental health and addiction treatment services--need to be strengthened, not abandoned. The ACA Medicaid expansions brought more than one million individuals into care for substance use and psychiatric disorders. Those individuals and families who have received such care and those who will need and receive or fail to receive such care in the future will hold you accountable for the decisions you make in the coming weeks. Choose wisely, for the country and for yourself. You will be held accountable for lives saved or lives lost.